Sebaceous cysts or herpes?

[RonMexico14]

Hi Doctor,

I haven't had oral or vaginal sex in the past year and a half (when I did it was always protected), I have mutually masturbated with two different partners during that time.

On 5/18 I noticed that I had 3 small reddish bumps on the underside of my penis' shaft.  They went away after a week.

After 3 weeks I had an intense pain in my penis that was kind of like a tingling from 6/14 to 6/21 that mainly occured when I was sitting or laying down.  Also when I initially started to urinate I felt a slight pain.

I noticed pain went away on 6/22 when I woke up in the morning but I also noticed 9 to 10 red bumps on the underside of my penis.  They weren't on the same base as I've read most herpes blisters are but kind of spread out a few centimeters between them.  I went to an STD Clinic to have them checked out but unfortunately they didn't have a herpes test.  When the nurse practitioner visually looked at them she said they were sebaceous cysts.  It is now 10 days after and the bumps are starting to get smaller, one of them has seemed to turn into a scab about the size of a pen point.

1)What are the differences in appearance between herpes and sebaceous cysts? Are they so easily distinguishable that I shouldn't be worried the NP made a wrong diagnosis in her visual examination?
2)Can sebaceous cysts recur a few weeks after they initially disappear?
3)Do sebaceous cysts usually scab like the one I described above?
4)Where is the best place to get an IgG antibody test done? I've called my primary provider and they said they don't offer any blood testing for herpes.

Thanks in advance for your answers.  I truly am grateful for the time you take out to answer our questions.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

Not being sexually active in the past several months, you are not at risk for any newly acquired STD.  Hand-genital contact carries no risk.  If your symptoms were due to STD, it would have to go back to a "real" sexual exposure somewhere along the line.  From your description, it seems unlikely that herpes explains your symptoms.

1) Penile pain like you describe really doesn't suggest any STD at all.  As for the bumps, distinguishing between sebaceous cysts/pimples and herpes is easy for any reasonably trained clinician, and most STD clinicians are expert in this area.  If she said the lesions didn't suggest herpes, I'm sure she is correct.  However, if you remain unconvinced, if and when a similar problem appears, return to the clinic ASAP, i.e. when the lesions are 1-2 days old. That's the time that visual diagnosis of herpes is most accurate.

2) Yes.

3) Any lesion that causes inflammation can scab as it heals.  This does not distinguish herpes from any other cause of a sore.

4) I have no way of knowing what providers in your area offer such testing.  Most STD clinics can do it -- if not routinely, at least the test usually is available on request.  Talk to the STD clinic about it.  If they simply don't do it, they likely would know health care providers in the area who do so.

Regards--  HHH, MD

[RonMexico14]

Thank you very much Dr. Handsfield for your quick, informative response.

I had one followup question about swollen lymph glands.  I've read that they are sometimes a symptom of herpes, but I'm not really sure what a swollen lymph gland is.  Before the first couple of bumps appeared I noticed a small circular bump right near the top of where my pubic hair ends, about an inch in from my thigh.  This bump felt like it was inside of the skin, everyone that has felt it has said it felt like an ingrown hair.  It went away shortly after the bumps on my penis went away and now there is a brownish mark on my skin where it was.  Is it possible that this was a swollen lymph gland?

I'm planning on going to get a blood test very soon, but figured I'd ask you about the swollen lymph to clear up some confusion I have about the topic.  Thanks again.

[H. Hunter Handsfield, M.D.]

Enlarged/inflamed lymph nodes typically show up as lumps under the skin, primarily in the neck, under the jaw, the armpits, and groin.  The lumps may or may not be tender to the touch.  Do not try to examine yourself to find any; medically untrained persons are susceptible to feeling minor variations in the tone and texture of normal tissues, and become panicked if they feel a lump.  If you otherwise feel healthy and well, there is no need to go looking for them.

That will have to be all for this thread.  Take care.

[RonMexico14]

Hi Dr. Handsfield,

I recently took an IgG antibody test (Captia EIA) and the results came back negative for both HSV-1 and HSV-2.  Thanks again for your insight during this stressful period in my life.

[H. Hunter Handsfield, M.D.]

You're the only one who might be surprised by that result.  But congratulations!